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Two papers have recently been published in Gut by Boparai et al.1 and Edelstein et al.2 regarding the risks of hyperplastic polyposis syndrome (HPS), also called serrated polyposis. Both suggest a substantial cancer risk and continued development of serrated polyps associated with the syndrome. Previous reports have suggested that the prevalence of hyperplastic polyposis syndrome is relatively low in the general population (1:3000; 0.033%)3 with recent correspondence in Gut from Orlowska4 on this issue suggesting even lower levels (1:100 000). However, we noticed a number of cases during bowel cancer screening colonoscopy based on guaiac faecal occult blood testing (gFOBT) and, therefore, formally assessed this within our screening cohort in an audit as part of service development. Currently, the NHS Bowel Cancer Screening Programme (BCSP) …

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